Text Size: A A A

Epidural Injection for Low Back and Leg Pain

Peer Reviewed

Nearly everyone experiences an episode of low back pain at one time or another during his or her lifetime. Often low back pain results from nerve compression. Typically, the patient's complaint includes a low backache or sharp pain traveling down one or both legs.

Common causes of pinched nerves include disc protrusions into the nerve space, arthritic facet joints with resultant narrowing of the spinal canal, and bone spurs. Less often, scar tissue that has formed from a previous surgery can cause nerve impingement and pain.

herniated disc

Nerves exit the spinal cord through the epidural space. Often, this space is utilized to deliver medicine in close proximity to the spinal nerves. The most effective medications include local anesthetics (numbing/deadens pain) and anti-inflammatory steroids, which help reduce swelling and inflammation that can lead to pinched nerves.

The Classic Epidural Injection
The epidural space is often accessed using a special type of injection. First, a sterile solution is applied to the target site. Next the site is numbed with a small injection of a local anesthetic. A special type of needle is used to identify the epidural space.

Specialists in pain management can offer techniques to overcome the deficiencies of this technique. Unfortunately, many patients do not experience complete relief of their pain. When complete pain relief is not achieved, the pain management specialist may carefully question the patient, utilize directed exam techniques, and radiographic studies to help guide more specific injections.

Epidural Injection Needle Guidance
A technique utilizing fluoroscopy is often used to guide the needle. The practitioner is able to watch the needle as it moves through tissues to its destination. Fluoroscopy makes it possible to place the medicine close to the exact lesion location (pinched nerve). In addition, modifications, such as a flexible guided catheter can be maneuvered into the proper position to deliver medication. Other modifications include injecting into the foramen, the spinal windows where the nerves exit.

The advent of injectable medications such as Clonidine, a drug originally used for high blood pressure, and Wydase, a protein which can dissolve scar tissue, have allowed epidural procedures to be at the forefront of modern pain management programs.

Updated on: 09/07/12
Leonardo Kapural, MD, PhD
Epidural injection procedures for management of low back and leg pain have significantly evolved over the last decade. The main purpose of such injections is to deliver medication as close as possible to the area of pathology, thereby avoiding the effects of orally administered steroids. It seems likely that the outcomes and potential complications may differ from one technical approach to another. One should also bear in mind that different technical approaches (like interspinal or transforaminal) may be needed for various spinal causes of back and leg pain. The main rationale for performing these minimally invasive procedures is their favorable risk/benefit ratio.
Cancel
Delete